Pathology Job Search 2011-2012

[KCShaw]

The 'letter of introduction' has kinda gone out of style, and asking for an LoR for a job just gives me the impression of a very young, academic employer. Perhaps it's just their particular little way. It may also be a side effect of some HR group/department, who tend to do odd things for odd reasons. But I don't particularly think it's a good sole reason to tell a potential employer to bugger off -- maybe ask them if they really mean 'references' if you like, but dumping them cold for that alone would probably be more peculiar to me than being asked for an LoR in the first place, other things being equal.

References, certainly. There are reasons why professionals tend to ask for and actually contact references directly rather than ask for LoR's.

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[2121115]

How strange is it to be asked to provide a letter of recommendation for a job????

I was asked to provide 3 letters to be considered. I'm used to providing references, but it seems silly to ask someone to write a letter for a job- just for someone to look at my CV and decide whether or not they want to call me. It feels like a grant application.

I kinda want to tell them I will provide references, and do no more- but I don't want to come off like a pompous arse.

I have never heard of a written letter of reference for a job. I would wonder about this practice, if they are requesting this.

 

[Pathguy11]

I am AP/CP-boarded (this November), did one fellowship, & am starting the 2nd one this July. I delayed the latter for family reasons. I'm looking for a position starting July 2013. We would like to move to a different area in order to be close to family; thus we are geographically-restricting our job search. The problem is, this state is small & there aren't many hospitals or labs, which is why I already started contacting people. I cold mailed & emailed 12 places within a 2-hour drive of our desired residence. I even stated that I would be willing to come for a visit this spring just to show that I'm not fooling around. The vast majority have not responded to my inquiries & those that do reply that there is no additional position needed at this time.

Should I try cold-calling people? Is that too intrusive? If they didn't reply to my email/mail before, would they simply find me to be a pain in the @$$ if I now called? I don't want to have my persistence backfire. Should I take the year off until something in the area opens up? Or is that career suicide? Do locums?

SO if I understand this correctly, you already have a fellowship lined up for next year. So I don't think you need to stress yet about jobs..you have some time. Most groups are not going to know if they are going to have opening for July 2013. If they have openings they will likely be filling immediately or with someone starting July 2012.

So , I think it is good to start contacting groups early, at least I did. But don't be discouraged that you will likely receive a combination of no reponses and "no opening available" this early in the game. I had the same responses. There is a fine line between following up every few months with a groups and being a pain. Use common sense with this. Maybe check in with groups by sending them an updated CV every few months to at least maintain some contact. After July 2012, you can start to inquire if they forsee possible opening in the future. For the groups that did not respond. Give them time..a few weeks or even month and perhaps contact them again just to "make sure they received your previoud coorespondance and CV." That is about all you can do this early in the game in my opinion. Below is a summary of my timeline that I posted earlier if that helps. Also, I wouldn't take time off if I were you unless I absolutely had too..just my opinion.

March - June 2011: This was the end of my first fellowship year and I would make a point to speak with the local Pathologists who sent our hospital consult cases. After telling them what we were going to sign the case out as, I would also tell them my situation, timeline and ask if they had any plans for group expansion during this time. Either way I would ask if I could send them a CV for their files. At this time no one knew of any opening but seemed fine with me sending a CV

July - August: This was my first effort to contact all the groups in my area that I had not already spoken to. I received mixed feedback that varied from "we are overstaffed as it is" to "we possibly will have something so keep in touch". But at least I had made first contact by this time

September- I learned of another group in the area, contacted them and sent a CV. they wanted to interview me right away and so I did. In the end this group wanted someone with more experience. I also touched base with a few groups that I had not contacted in a couple of months. I had a verbal offer for an interview with another group that was suppose to be towards the end of Sept. but they filled the position with someone with 10 years experience, so I never interviewed there.

October & November: I had three interviews this month. One was a group that had previous said they would not have an opening but unexpectedly one became available. Another small group I only learned about in October and when I contacted them they wanted to interview me. The third group was really wierd. When I met with this third group they basically told me that they definintely had a position for me and wanted to set up a second interview with other partners. This second interview never happened and I found out they had told other applicant the same line.

December: I went on second interviews for two groups that I interviewed with in November and eventually received job offers from both groups.

January: I officially signed a contract with one group. Very happy with my decision

February: I received a phone call from another group I had spoken with back in August and was told that they "may" have an opening that they would like me to interview for. I also heard about another part-time position that is available in my area with primary focus on Cytopathology signout. And finally, there is at least one academic center that I am aware of with two faculty position that they are finally starting to interview for.

Pathguy11

 

[gbwillner]

The 'letter of introduction' has kinda gone out of style, and asking for an LoR for a job just gives me the impression of a very young, academic employer. Perhaps it's just their particular little way. It may also be a side effect of some HR group/department, who tend to do odd things for odd reasons. But I don't particularly think it's a good sole reason to tell a potential employer to bugger off -- maybe ask them if they really mean 'references' if you like, but dumping them cold for that alone would probably be more peculiar to me than being asked for an LoR in the first place, other things being equal.

References, certainly. There are reasons why professionals tend to ask for and actually contact references directly rather than ask for LoR's.

I asked them to clarify since they asked for "letter of reference." They definitely want a LOR. Kind of annoying- I need to think about how much I would want this job to bug people for the letter, without actually knowing much about it except for the job posting.

 

[mlw03]

I asked them to clarify since they asked for "letter of reference." They definitely want a LOR. Kind of annoying- I need to think about how much I would want this job to bug people for the letter, without actually knowing much about it except for the job posting.

Weird. Thanks for sharing. I guess in an "employer's" job market, they can make these kinds of requests and still figure to get an adequate number of decent applicants.

To give a bit of an update to the theme of this thread, I am comfortable sharing that my co-fellows (forensic path, 2 of them) each now have jobs lined up for next year. And each of them ended up with multiple offers from which to choose. Obviously not applicable to the diagnostic path job market, but something for residents thinking about which fellowship/career to pursue to consider. I'll also add after coming back from one of our big national meetings that there seem to be plenty of forensic pathologists age 50+, and unlike diagnostic path, forensic path is a bit physically demanding and not something most folks are going to want to do into their late 60s and beyond. Seems like a promising job markets in the coming years.

 

[deleted314957]

Weird. Thanks for sharing. I guess in an "employer's" job market, they can make these kinds of requests and still figure to get an adequate number of decent applicants.

To give a bit of an update to the theme of this thread, I am comfortable sharing that my co-fellows (forensic path, 2 of them) each now have jobs lined up for next year. And each of them ended up with multiple offers from which to choose. Obviously not applicable to the diagnostic path job market, but something for residents thinking about which fellowship/career to pursue to consider. I'll also add after coming back from one of our big national meetings that there seem to be plenty of forensic pathologists age 50+, and unlike diagnostic path, forensic path is a bit physically demanding and not something most folks are going to want to do into their late 60s and beyond. Seems like a promising job markets in the coming years.

That is not a bad idea at all. Even 25 years ago I did my forensic fellowship/got boards and served a couple years as a district associate M.E. in a state with governmental M.E. districts (while i was in a PP group), largely as a back-up/insurance policy if traditional pathology went to hell. It largely has but it was after my time and I never had to use it as a fall back position, although I try to keep up w the literature and current textual material. There is no denying it is an interesting field.

 

[mlw03]

That is not a bad idea at all. Even 25 years ago I did my forensic fellowship/got boards and served a couple years as a district associate M.E. in a state with governmental M.E. districts (while i was in a PP group), largely as a back-up/insurance policy if traditional pathology went to hell. It largely has but it was after my time and I never had to use it as a fall back position, although I try to keep up w the literature and current textual material. There is no denying it is an interesting field.

Definitely interesting, but totally different as everyone here knows. I honestly think part of the lack of interest by path residents is because of the low pay. Even an experienced ME in the US is going to top out in the upper 100s to low 200s, while someone with a hemepath fellowship may start in the low 200s, with much upward potential. The other big downside is that because we're so niche, you rarely can choose where you want to go live and work, rather you must go where the job is. So there's no changing those things, but I will also say I don't know any recent FP fellows who were not able to find a job somewhere, and that's not something you can say about other subspecialties within pathology.

 

[DocGul]

The only question is should I take a job not that desiable, or do a fellowship, like cytopath, which may in the long run payoff better. Some say there are too many candidates with cytopath training already. It's not gonna make any difference.

 

[Tissue issue]

The only question is should I take a job not that desiable, or do a fellowship, like cytopath, which may in the long run payoff better. Some say there are too many candidates with cytopath training already. It's not gonna make any difference.

Please describe the job that you have been offered.

 

[2121115]

The only question is should I take a job not that desiable, or do a fellowship, like cytopath, which may in the long run payoff better. Some say there are too many candidates with cytopath training already. It's not gonna make any difference.

I'd be interested in the details, but take the job. Otherwise next year you will be in the same position you are in now.

 

[TMZ2007]

Definitely take the job; even if it's terrible and you hate your colleagues you'll at least have two real, tangible benefits over another fellowship year: at least 3x the salary and a year of practice experience.

 

[deleted314957]

Take the job. That is the whole object. A cytopath fellowship won't help. We all do cytopath.

 

[LADoc00]

Mike-

Wasnt 25 years ago the glory days of Pathology?? With mad CP billings and high total reimbursements?

What made you think it was all going to hell back then?

 

[inpursuit]

I got an offer in an academic institute doing Surg path and cyto. The offer is $150k with 3 wks service a month and a week off for "academic" time. Does that sound reasonable? I felt it was a little rough. Have asked for time to consider. I have a couple other places where I interviewed who seemed interested. Should I ask for an offer to compare places?

 

[deleted314957]

Mike-

Wasnt 25 years ago the glory days of Pathology?? With mad CP billings and high total reimbursements?

What made you think it was all going to hell back then?

CLIA and DRG's made me very scared. things were very good though. in 1992 i made $700K.
Almost forgot the worst-TEFRA 1982

 

[deleted57552]

I got an offer in an academic institute doing Surg path and cyto. The offer is $150k with 3 wks service a month and a week off for "academic" time. Does that sound reasonable? I felt it was a little rough. Have asked for time to consider. I have a couple other places where I interviewed who seemed interested. Should I ask for an offer to compare places?

What rank are they appointing you at?

Quite a few academic places only give you 25% to 33% protected time. Offering you $150K and making you sign out 75% of the time is abuse. The low pay could be explained by appointing you as an instructor. But some places will appoint you as an assistant professor at that salary level. That is quite sad. If you are serious about academics, you want to go somewhere that gives you close to 50% and pays you more.

Hold out and see if you get other offers; in fact, since you have an offer in hand already, you can ask for offers (if you are serious about considering that one offer)...your best negotiating tool is a competing offer. You can pit one institution against another and you could have a really nice appointment package wherever you end up. If this place pressures you, you don't want to work for them.

 

[inpursuit]

What rank are they appointing you at?

Quite a few academic places only give you 25% to 33% protected time. Offering you $150K and making you sign out 75% of the time is abuse. The low pay could be explained by appointing you as an instructor. But some places will appoint you as an assistant professor at that salary level. That is quite sad. If you are serious about academics, you want to go somewhere that gives you close to 50% and pays you more.

Hold out and see if you get other offers; in fact, since you have an offer in hand already, you can ask for offers (if you are serious about considering that one offer)...your best negotiating tool is a competing offer. You can pit one institution against another and you could have a really nice appointment package wherever you end up. If this place pressures you, you don't want to work for them.

That is what I thought too. This is an assistant attending position in a large institution. The reason for choosing academia was so I get protected time off service for research. It doesn't seem like that is what I will be allowed to do here.
Also what kind of salary range would one expect for an assistant attending position in academia? I just want a ball park figure so I know that they are not low balling me.

And thanks for your advice. Will do.

 

[KCShaw]

Definitely interesting, but totally different as everyone here knows. I honestly think part of the lack of interest by path residents is because of the low pay. Even an experienced ME in the US is going to top out in the upper 100s to low 200s, while someone with a hemepath fellowship may start in the low 200s, with much upward potential. The other big downside is that because we're so niche, you rarely can choose where you want to go live and work, rather you must go where the job is. So there's no changing those things, but I will also say I don't know any recent FP fellows who were not able to find a job somewhere, and that's not something you can say about other subspecialties within pathology.

Given that there are people without forensic fellowships, and certainly those with fellowship but no FP boards, who are getting jobs in the field, I would suggest FP may well be the most open pathology market currently available. The salary range is generally narrower, but frankly there is a lot of opportunity for entrepreneurial types to start or expand private groups covering forensic cases (not just 'private' or hospital cases). Coroner jurisdictions are always looking for a cheaper alternative, and some of the government based ME offices are, I think, rife with opportunity for conversion to private or semi-private operation...assuming it can be done on a lower budget (which I believe is not only possible, but probable, with suitable facilities available).

As for surgical pathology in academia, my admittedly very limited exposure to those starting salaries (~$120) put it at or below that of most starting FP's (~$150), for what it's worth -- which may not be much, as I'm talking about a tiny n. I'm not aware the upper end being much better than an FP either, on average. Obviously, the day to day job is markedly different, of course.

 

[Pathguy11]

That is what I thought too. This is an assistant attending position in a large institution. The reason for choosing academia was so I get protected time off service for research. It doesn't seem like that is what I will be allowed to do here.
Also what kind of salary range would one expect for an assistant attending position in academia? I just want a ball park figure so I know that they are not low balling me.

And thanks for your advice. Will do.

Just curious if there were any yearly bonuses that are offered by the institution, as some academic institutions have this sort of thing and it can make the base salaries more competitive. I agree that $150k starting doesn't sound like much but without taking into account other benefits that you might receive, it may be close to numbers I have seen for starting academia. I am not sure what region of the country you are in, as that can affect things, but I found this interesting website for academic institutions in Texas. Seems that all state employees salaries in Texas are published including physicians. It is on the Texas Tribune website.

http://www.texastribune.org/library/data/government-employee-salaries/agencies/

You can search under "agency" and can select places like UT Southwestern Medical Center, UT Health Sciences Center at Houston (UT-Houston), MD Anderson, UT Medical Branch, UT Health Science San Antonio, etc. Let's say you select University of Texas Medical Branch then look under "department" on the first page about half way down and you will see "Pathology Faculty". Click on "Pathology Faculty". You then get a list from highest to lowest of all the Path faculty at UT Medical Branch and their title (professor, assistant prof, associate prof, etc). You can basically do this for the other institutions. Perhaps other states have something similar? Anyway, perhaps this will help some. Also remember that the salaries listed are base salaries and do not include additional benefits or bonuses.

Pathguy11

 

[BU Pathology]

That is what I thought too. This is an assistant attending position in a large institution. The reason for choosing academia was so I get protected time off service for research. It doesn't seem like that is what I will be allowed to do here.
Also what kind of salary range would one expect for an assistant attending position in academia? I just want a ball park figure so I know that they are not low balling me.

And thanks for your advice. Will do.

The AAMC publishes a compensation survey every year. The compensation includes base salary plus bonuses but not benefits. It is divided by region of the country and public vs private medical school. Most libraries have a copy of this and you can see directly what the typical compensation will be.

25% protected time (13 weeks of no assigned sign out) and a 150K salary would be very typical starting position. If you are K08 eligible, or better yet already submitted a K08, then your protected time will move to 75%.

 

[pathstudent]

I got an offer in an academic institute doing Surg path and cyto. The offer is $150k with 3 wks service a month and a week off for "academic" time. Does that sound reasonable? I felt it was a little rough. Have asked for time to consider. I have a couple other places where I interviewed who seemed interested. Should I ask for an offer to compare places?

Usually you get 4-5 weeks of vacation time too. Specify if that has to come out of your protected time for research. A man can't work 52 out of 52 and if your 4-5 weeks off come out of your protected time, then there is nothing protected about it.

 

[cjw0918]

I got an offer in an academic institute doing Surg path and cyto. The offer is $150k with 3 wks service a month and a week off for "academic" time. Does that sound reasonable? I felt it was a little rough. Have asked for time to consider. I have a couple other places where I interviewed who seemed interested. Should I ask for an offer to compare places?

That's basically my job as an asst professor. I get paid slightly more with slightly less off-service time. Only 3 weeks vacation time. The first few days of off-service are always spent finishing cases, so it's really less than advertised. And yes, vacation comes out of off service time. In fact when I return from maternity leave, I will work about 6 months straight without an off-service week to cover my maternity leave. Isn't that nice??

There's no question that these academic jobs suck. I am not planning on this being a forever job. On the plus side, I am still learning a lot and I like my pathology colleagues. And the dept is big enough to absorb my maternity leave with minimal pissing off of other people.

 

[mlw03]

I got an offer in an academic institute doing Surg path and cyto. The offer is $150k with 3 wks service a month and a week off for "academic" time. Does that sound reasonable? I felt it was a little rough. Have asked for time to consider. I have a couple other places where I interviewed who seemed interested. Should I ask for an offer to compare places?

This is what I saw of junior faculty where I did residency (medium size midwestern city). They did seem to work very, very hard, and there was a fair amount of turnover at that level.

 

[inpursuit]

Just curious if there were any yearly bonuses that are offered by the institution, as some academic institutions have this sort of thing and it can make the base salaries more competitive. I agree that $150k starting doesn't sound like much but without taking into account other benefits that you might receive, it may be close to numbers I have seen for starting academia. I am not sure what region of the country you are in, as that can affect things, but I found this interesting website for academic institutions in Texas. Seems that all state employees salaries in Texas are published including physicians. It is on the Texas Tribune website.

http://www.texastribune.org/library/data/government-employee-salaries/agencies/

You can search under "agency" and can select places like UT Southwestern Medical Center, UT Health Sciences Center at Houston (UT-Houston), MD Anderson, UT Medical Branch, UT Health Science San Antonio, etc. Let's say you select University of Texas Medical Branch then look under "department" on the first page about half way down and you will see "Pathology Faculty". Click on "Pathology Faculty". You then get a list from highest to lowest of all the Path faculty at UT Medical Branch and their title (professor, assistant prof, associate prof, etc). You can basically do this for the other institutions. Perhaps other states have something similar? Anyway, perhaps this will help some. Also remember that the salaries listed are base salaries and do not include additional benefits or bonuses.

Pathguy11

Year end bonus was 5-10K I was told. And this is a big east coast program. The Texas Tribune website provided an interesting read. Thanks!

That's basically my job as an asst professor. I get paid slightly more with slightly less off-service time. Only 3 weeks vacation time. The first few days of off-service are always spent finishing cases, so it's really less than advertised. And yes, vacation comes out of off service time. In fact when I return from maternity leave, I will work about 6 months straight without an off-service week to cover my maternity leave. Isn't that nice??

There's no question that these academic jobs suck. I am not planning on this being a forever job. On the plus side, I am still learning a lot and I like my pathology colleagues. And the dept is big enough to absorb my maternity leave with minimal pissing off of other people.

That does suck. 3 weeks vacation and practically no off service time. No matter how much I enjoy signing out cases I need the time to be academically productive if I am planning to be successful in academia. You will be too busy finishing up left over cases in that measly less than a week off-service time. That does suck.

This is what I saw of junior faculty where I did residency (medium size midwestern city). They did seem to work very, very hard, and there was a fair amount of turnover at that level.

But of course. I'm so depressed.

 

[mlw03]

Then why are you considering this job? Academic path is what it is only because they find willing people to do the work.

 

[pathstudent]

That's basically my job as an asst professor. I get paid slightly more with slightly less off-service time. Only 3 weeks vacation time. The first few days of off-service are always spent finishing cases, so it's really less than advertised. And yes, vacation comes out of off service time. In fact when I return from maternity leave, I will work about 6 months straight without an off-service week to cover my maternity leave. Isn't that nice??

There's no question that these academic jobs suck. I am not planning on this being a forever job. On the plus side, I am still learning a lot and I like my pathology colleagues. And the dept is big enough to absorb my maternity leave with minimal pissing off of other people.

That is a real **** schedule there. 3 weeks off? I had more than that in residency. And if you only have 5 weeks or so left of protected time (where of course a couple days will be spent cleaning up), how can you find meaningful time for writing publications?

 

[mlw03]

Not trying to pick a fight, but then why did you take this job? Again, I'll state that these situation exist because academic path departments are able to find people willing to take these jobs. If pathologists stopped being willing, working conditions would presumably have to improve to attract adequate candidates.

That's basically my job as an asst professor. I get paid slightly more with slightly less off-service time. Only 3 weeks vacation time. The first few days of off-service are always spent finishing cases, so it's really less than advertised. And yes, vacation comes out of off service time. In fact when I return from maternity leave, I will work about 6 months straight without an off-service week to cover my maternity leave. Isn't that nice??

There's no question that these academic jobs suck. I am not planning on this being a forever job. On the plus side, I am still learning a lot and I like my pathology colleagues. And the dept is big enough to absorb my maternity leave with minimal pissing off of other people.

 

[1 Path]

Not trying to pick a fight, but then why did you take this job? Again, I'll state that these situation exist because academic path departments are able to find people willing to take these jobs. If pathologists stopped being willing, working conditions would presumably have to improve to attract adequate candidates.

The perceived quality of the job market is highly dependent on your geographic flexibility-many residents/fellows are constrained by family, spouse's career, etc. If you finish training, and you can't move a long distance without causing significant family disruption, then staying on at your training program as junior faculty may be the best available option. At my prior training program this was common, with most of the junior AP faculty being former residents/fellows who simply stayed. Eventually some will drift into private practice as options become available.

I should emphasize that I am not denigrating these jobs; it all depends on what you want for your career. Currently it seems that private practice/partnership track jobs are in comparatively short supply. This could change-e.g. if health care reform crushes reimbursement for private practice and eliminates the pay differential.

 

[2121115]

That's basically my job as an asst professor. I get paid slightly more with slightly less off-service time. Only 3 weeks vacation time. The first few days of off-service are always spent finishing cases, so it's really less than advertised. And yes, vacation comes out of off service time. In fact when I return from maternity leave, I will work about 6 months straight without an off-service week to cover my maternity leave. Isn't that nice??

There's no question that these academic jobs suck. I am not planning on this being a forever job. On the plus side, I am still learning a lot and I like my pathology colleagues. And the dept is big enough to absorb my maternity leave with minimal pissing off of other people.

Wow that is terrible. Actually both the academic positions listed in this thread are terrible deals.

To the poster considering the academic position - 3 weeks vacation? Vacation coming out of off service time? LOL. Also, if you are in high volume sign out, most of your "off service" time will be used finishing your cases from the previous 3 weeks (I have been told this by essentially every young academic attending I have talked to), but don't think that will lessen the publishing requirement!

Look. Academic pathology is an abusive environment. Far worse than the average private practice. I have seen it time and time again. There is marked turnover at supposedly "prestigious" institutions because they are banking on you thinking that the name value is worth $$$. Over worked. Under paid. If ever there was a place where pathology over supply rears its ugly head, it is with junior attendings at academic institutions. You think your radiology and anesthesia colleagues are going to work in an academic center for a deal like that? LOL. Pathology has major, major issues.

 

[2121115]

This could change-e.g. if health care reform crushes reimbursement for private practice and eliminates the pay differential.

Why would it eliminate the pay differential? It may lower pay, but it will lower pay for everyone. Where do you think the junior attending salary comes from? The 88305's and 88307's, etc that the department bills for their work. When those CPT codes get reimbursement cuts, who do you think is going to absorb the cut? The senior academics who work less, get paid more, and pull the strings? You think they are going to decrease departmental funding for lab rat research? You think the medical school is going to get by with less? Ha. No. They will cut the assistant professor's salary even lower than it is now. Then good luck jumping ship to a private practice, since they won't be hiring due to reimbursement cuts.

 

[DrBloodmoney]

Currently it seems that private practice/partnership track jobs are in comparatively short supply. This could change-e.g. if health care reform crushes reimbursement for private practice and eliminates the pay differential.

Obamacare is going to pull the rug out from under private practice pathologists.

 

[cjw0918]

Not trying to pick a fight, but then why did you take this job? Again, I'll state that these situation exist because academic path departments are able to find people willing to take these jobs. If pathologists stopped being willing, working conditions would presumably have to improve to attract adequate candidates.

No offense taken. It's a fair question. I am tied to one city. My husband is also a pathologist and he is happy in his position. I was offered a private practice job, but it was a practice in which pathologists kept leaving due to work dissatisfaction.

I was disappointed that I could not find a nice private job, but it was just not available at the time. And I did not want a gap in employment. I am making the best of the situation now.

As for publications, I have not had time. I know I am essentially in a dead end job as I will never be promoted without these, but I do not want to spend my weekends doing research. In the mean time I'll just keep seeing great cases and gaining experience. Hopefully something better will come along.

 

[pathstudent]

The perceived quality of the job market is highly dependent on your geographic flexibility-many residents/fellows are constrained by family, spouse's career, etc. If you finish training, and you can't move a long distance without causing significant family disruption, then staying on at your training program as junior faculty may be the best available option. At my prior training program this was common, with most of the junior AP faculty being former residents/fellows who simply stayed. Eventually some will drift into private practice as options become available.

I should emphasize that I am not denigrating these jobs; it all depends on what you want for your career. Currently it seems that private practice/partnership track jobs are in comparatively short supply. This could change-e.g. if health care reform crushes reimbursement for private practice and eliminates the pay differential.

It is astounding how little people training in pathology know about the nuts and bolts about medicine as a business. Private practice does not receive greater reimbursement. Medicare pays the same for a given cpt code to a university as it does to a small private practice group.

People, academic salaries are not lower because of how revenue is generated. In fact academic pathology departments certainly generate far greater revenue per a similar case as a small private group because academic/training pathologists tend to order far more tests on a given case. For example we ordered cytogentics on every single soft tissue tumor even if it was obviously a lipoma. Out of the 100 or so cases I saw I can ony remember onE timewhere the pathologist said, "let's wait until the cytogentics comes back before signing this out." and for that case I think we ordered the specific fish probe for the translocation anyway. So with the other 99 cases the cytogenetic work-up didn't do anything except generate revenue for the department.

Obamacare will crush or not crush private practice revenue no more or no less than academic revenue

 

[1 Path]

Why would it eliminate the pay differential? It may lower pay, but it will lower pay for everyone. Where do you think the junior attending salary comes from? The 88305's and 88307's, etc that the department bills for their work. When those CPT codes get reimbursement cuts, who do you think is going to absorb the cut? The senior academics who work less, get paid more, and pull the strings? You think they are going to decrease departmental funding for lab rat research? You think the medical school is going to get by with less? Ha. No. They will cut the assistant professor's salary even lower than it is now. Then good luck jumping ship to a private practice, since they won't be hiring due to reimbursement cuts.

To clarify, I don't necessarily expect the differential will completely disappear, but I will be pleasantly surprised if it doesn't decrease significantly. Several factors:

1. Currently for PP, a significant portion of income comes from relatively 'soft' money. Lab management fees, hourly fees for serving on committees, etc. Some practices still receive professional component compensation on lab tests (CBC etc). As health systems get squeezed by healthcare reform, I think this soft money will disappear. Loss for PP, the young academic surgical pathologist isn't getting any of this money anyway so nothing to lose. Gap narrows.

2. Average PP partner is probably making close to 3X that of the young academic surgical pathologist. Cut the PP partner's salary by half, their best economic option is probably still to practice pathology. You can't cut the academic's salary by 50%; then they would be better off leaving medicine entirely or becoming an RN or something. In my opinion there is a salary 'floor' below which you simply cannot retain a physician's services (not just pathology). The academic is already much closer to this floor, which will eventually exert upward pressure on starting academic salaries.

3. The young academic pathologist is probably signing out many more 8830x's than the private practice partner. Currently the PP is making up for this in part by a better payor mix-private insurance may pay 2-3X (or more) what medicare/medicaid/Tricare etc pay. Most private hospitals get a large share of insured patients, with a disproportionate share of uninsured/indigent patients going to medical centers with county hospitals and large trauma programs. If we go to a true universal health care solution, there will be fewer indigent/non-paying patients at the county hospitals (so the academic generates more revenue) and the PP loses out on the current lucrative well insured population. I'm not saying universal healthcare is inherently good or bad, either in general or for overall reimbursement, just that it may tend to homogenize reimbursement per CPT across practice environments.

4. In the short term, the large corporate labs are much more of a threat-and competition-to private practice than an academic center. More competition almost always exerts downward pressure on prices through one mechanism or another. For example, an academic center is not going to let their uros and gastros start sending their biopsies outside the system, whereas for PP more and more of these higher yield specimens are slipping away due to pod labs, corporate 'reference' specialty labs, etc.

Just my opinion, who knows what will happen.

 

[1 Path]

It is astounding how little people training in pathology know about the nuts and bolts about medicine as a business. Private practice does not receive greater reimbursement. Medicare pays the same for a given cpt code to a university as it does to a small private practice group.

Yes medicare does pay the same (by region). However, in our current health care system, many patients are employed and have something called 'health insurance.' Often this 'health insurance' pays more than medicare/medicaid. The county hospital where I trained had many medicare/medicaid or indigent/uninsured patients, and the hospital where I practice has many patients with higher paying private insurance.

I think it is relatively rare for a private practice pathology group to staff a county/charity hospital. Why might this be?????

It is astounding that anyone could discuss medical economics as if medicare was the only payor...

 

[deleted57552]

That is what I thought too. This is an assistant attending position in a large institution. The reason for choosing academia was so I get protected time off service for research. It doesn't seem like that is what I will be allowed to do here.
Also what kind of salary range would one expect for an assistant attending position in academia? I just want a ball park figure so I know that they are not low balling me.

And thanks for your advice. Will do.

165K-170K. You need 50% protected time. Yes, some people in academia are blessed this way. You should have the chance to experience this joy as well. If you're going to work 75% on service (and remember, this doesn't include the extra days to finish your follow-ups), you might as well be in private practice with 12 weeks of vacation. Seems like this arrangement is typical of many academic institutions where junior faculty are abused and forced to "put in their time" by working a lot on service while the upper echelon faculty work less. With <25% protected time, you're not going to get any meaningful research done unless you work from home and stress yourself out to no end. You want to go to an academic department where the work is equitably divided; where clinical track professors work a similar amount as junior faculty. I suspect this is uncommon; but these places do exist!

 

[deleted57552]

Just curious if there were any yearly bonuses that are offered by the institution, as some academic institutions have this sort of thing and it can make the base salaries more competitive.

Some places reward faculty with bonuses based on departmental financial margins and how this money is distributed can be weighted based on how many weeks of service (or extra service) a faculty member works. Although this looks appealing from the surface, this reward system is actually anti-academic because it rewards people financially for volunteering away their protected time. You tend to see this at academic institutions who have a private practice flavor to them since they have private-practice mentality businessmen running the finances. One institution in the state of North Carolina comes to mind.

 

[deleted57552]

There is marked turnover at supposedly "prestigious" institutions because they are banking on you thinking that the name value is worth $$$. Over worked. Under paid. If ever there was a place where pathology over supply rears its ugly head, it is with junior attendings at academic institutions.

So true. Prestigious institutions do give junior faculty a sense of security though as junior faculty perceive that they are surrounded by excellence (i.e., experts to show the cases to). But some people need that "name" to feel secure about themselves as people. The strong, confident people are opportunistic and are not afraid to steer clear of "name" institutions.

IMHO - great to train at a Harvard or Hopkins but not good to be a junior faculty member there. Better to train at a Harvard or Hopkins, take that knowledge, and move somewhere else!

OK, I think I have exceeded my self-allowed posting quota for 2012. See you next year.

 

[pathstudent]

Yes medicare does pay the same (by region). However, in our current health care system, many patients are employed and have something called 'health insurance.' Often this 'health insurance' pays more than medicare/medicaid. The county hospital where I trained had many medicare/medicaid or indigent/uninsured patients, and the hospital where I practice has many patients with higher paying private insurance.

I think it is relatively rare for a private practice pathology group to staff a county/charity hospital. Why might this be?????

It is astounding that anyone could discuss medical economics as if medicare was the only payor...

Well duh. Private groups don't staff county hospitals because the pathologists are county employees and even if a county hospital is affiliated with university often (not always) they only have an academic appointment and aren't paid out of the academic fund. Same with v.a. Hospitals affiliated with universities. The v.a. docs are paid by the federal government not by the prestigious university. So your whole point is totally irrelevant and makes no sense. If you think the salaries at MDA, MSK, mayo, Stanford, Cleveland clinic, and BWH are lower because the majority of the patients are charity cases, you are wrong.

In terms of how private insurance reimburses it varies from group to group depending on the contract with the insurance company but more or less it will be the same. Private practice docs make more money because they sign out more cases per year and run leaner more efficient operations.

 

[1 Path]

Well duh. Private groups don't staff county hospitals because the pathologists are county employees and even if a county hospital is affiliated with university often (not always) they only have an academic appointment and aren't paid out of the academic fund. Same with v.a. Hospitals affiliated with universities. The v.a. docs are paid by the federal government not by the prestigious university. So your whole point is totally irrelevant and makes no sense. If you think the salaries at MDA, MSK, mayo, Stanford, Cleveland clinic, and BWH are lower because the majority of the patients are charity cases, you are wrong.

In terms of how private insurance reimburses it varies from group to group depending on the contract with the insurance company but more or less it will be the same. Private practice docs make more money because they sign out more cases per year and run leaner more efficient operations.

Perhaps I should simplify-

There are many factors involved in setting academic salaries. For academics, it is hard to predict how federally administered universal coverage and/or the probably inevitable experiment with ACO's will alter faculty salary as the linkage between billing and faculty salary is complicated and indirect. My guess is that junior academic pathologist salaries will not change much due to the many complex factors involved in setting those salaries.

By contrast, in PP there is a direct link between anatomic billing/collections and how much a partner takes home. At least for my region, some payers reimburse at over twice the rate of others for the exact same CPT code, with medicare/medicaid being at the lower end of the scale. My only assumption is that universal coverage and/or ACO's will push average reimbursement for anatomic pathology closer to the current low-end (medicare) levels. When that happens, the work a partner does in a private group will generate less revenue-and that partner's income will be reduced proportionally. As a result of this reduction, academic and private salaries will be much closer than they currently are.

I do not think I can explain any more clearly than that. If you are envisioning a scenario where ACO's and/or federally mandated universal coverage will somehow increase reimbursement in a way that favors private practice over academics, leading to a rise in private salaries, I would be very interested in the details of how that might work.

 

[path24]

Exploited by academics or corporate lab? Who would have thought Labcorp is the better option. Both pushing for the continued oversupply.

Why do people take the job in academics? Poor job market and you have to put food on your table and payback the massive student loans. Who can afford to end training without a job?

More reasons to stay away from path....not that they are needed.

 

[PathRes123]

Is it common for university academic medical centers to have non-compete clauses? For some reason, I always thought it was a private thing and am a little surprised to find it in a sample contract at an academic center...

Thanks

 

[2121115]

Is it common for university academic medical centers to have non-compete clauses? For some reason, I always thought it was a private thing and am a little surprised to find it in a sample contract at an academic center...

Thanks

No, it is quite common. As I and others have suggested before, academic centers pay the bills the same way private practices do, from billing the exact same CPT codes for anatomic pathology. When pathologists jump ship from an academic center, it affects them the same way it affects a private group. For instance, many academic hospitals now do outreach stuff buying up private clinical practices. They don't want a respected GI pathologist (for instance) to leave and go to a private group and take the outreach pathology business with them. It hurts the department's bottom line. Academics is as much about business as a private group, it is just that in academics the $$ doesn't make it's way back to the people who do the work like it does in private practice.

Where I trained everyone who joined the academic department (assistant prof's, clinical prof's, etc) had to sign a very restrictive non-compete clause. If you wanted to jump to a community practice in town (or within several hundred miles or something ridiculous like that) you had to pay the department a serious amount of $$$ to buy out the non-compete. This complicated the careers of some of the young faculty who took the academic job because they wanted to be in this particular area - but once they got tired of being worked to death for little pay as a junior faculty, they sought and got an offer in a local private practice only to find they couldn't wiggle out of the non-compete without paying a huge amount of $$$ in cash to the department (which they didn't usually have on hand).

I will say this: read those contracts carefully and consider the implications for the future.

 

[mlw03]

Interesting post. How negotiable are the non-compete clauses? Sounds like a bit of a game of chicken, ie who wants the other more?

No, it is quite common. As I and others have suggested before, academic centers pay the bills the same way private practices do, from billing the exact same CPT codes for anatomic pathology. When pathologists jump ship from an academic center, it affects them the same way it affects a private group. For instance, many academic hospitals now do outreach stuff buying up private clinical practices. They don't want a respected GI pathologist (for instance) to leave and go to a private group and take the outreach pathology business with them. It hurts the department's bottom line. Academics is as much about business as a private group, it is just that in academics the $$ doesn't make it's way back to the people who do the work like it does in private practice.

Where I trained everyone who joined the academic department (assistant prof's, clinical prof's, etc) had to sign a very restrictive non-compete clause. If you wanted to jump to a community practice in town (or within several hundred miles or something ridiculous like that) you had to pay the department a serious amount of $$$ to buy out the non-compete. This complicated the careers of some of the young faculty who took the academic job because they wanted to be in this particular area - but once they got tired of being worked to death for little pay as a junior faculty, they sought and got an offer in a local private practice only to find they couldn't wiggle out of the non-compete without paying a huge amount of $$$ in cash to the department (which they didn't usually have on hand).

I will say this: read those contracts carefully and consider the implications for the future.

 

[PathRes123]

Are non-competes negotiable? As in - I don't want it!

Although as I join, I am not thinking of leaving the institution,I do not want to be ruled out of ever working in a city I am relocating to because of such a clause.

 

[Pathguy11]

Is it common for university academic medical centers to have non-compete clauses? For some reason, I always thought it was a private thing and am a little surprised to find it in a sample contract at an academic center...

Thanks

Another question would be how well do non-compete clauses actually hold up in court. Fortunately my groups clause is not too bad but the converation did come up with my contract lawyer. He said they can be a pain to deal with but typically they do NOT hold up in court if you are not jeopardizing the group financially. He said it would be one thing if you are simply wanting to leave the group and join another one, as opposed to leaving and try take business/contract with you. Not sure what the correct answer is but this was just one lawyer's opinion.

Pathguy11

 

[Tissue issue]

Are non-competes negotiable? As in - I don't want it!

Although as I join, I am not thinking of leaving the institution,I do not want to be ruled out of ever working in a city I am relocating to because of such a clause.

That question is hard to answer without knowing the character of the chairperson and the board/suits of the institution. Institutions may be inclined to take the hard line and not ever consider altering their standard contract- do it once and they may have to do it for all.
Is that corporate lab job you were offered still an option or did you decline the offer? It may be best to consider job offers "as is" and not how you would like them to be- not saying this to be a downer, just the reality of our situation, of course compounded by our lack of leverage due to oversupply.

 

[2121115]

Are non-competes negotiable? As in - I don't want it!

Although as I join, I am not thinking of leaving the institution,I do not want to be ruled out of ever working in a city I am relocating to because of such a clause.

Everything is negotiable if they want you bad enough.

(HINT: If you are a new grad, they don't want you bad enough)

 

[Pathguy11]

It's been a while since anyone has posted about their job search results so I thought I would bring the topics back up. Please share your experiences and the experiences of those you know who are looking for employment for July 2012. Below is a template of information that you may consider sharing...

Estimated CV sent out:
Total interviews completed:
Remaining interviews scheduled:
Number of job offers:
Practice setting offered:
Partnership track:
Reason for job opening:
Location:
Residency Training:
Fellowship:
Board certification:
State medical license:

Thanks

Pathguy11

 

[pathstudent]

Another question would be how well do non-compete clauses actually hold up in court. Fortunately my groups clause is not too bad but the converation did come up with my contract lawyer. He said they can be a pain to deal with but typically they do NOT hold up in court if you are not jeopardizing the group financially. He said it would be one thing if you are simply wanting to leave the group and join another one, as opposed to leaving and try take business/contract with you. Not sure what the correct answer is but this was just one lawyer's opinion.

Pathguy11

Based on my experience and from discussions from others they don't hold up. I know of anesthesiologists who left their group and worked at the same hopsital and surgeons who the group worked for. The maverick anesthesiologists were sued by their old group but the group lost in court. These guys were directly taking business from their old group and the non-compete clause wasn't worth the piece of paper it was written on.

However, let's say you work for Ameripath and want to leave because you are sick of their bull**** and you go to a competing group across the street and some doc that likes you sends you their outpatient biopsies or bone marrows or whatever. There is no way Ameripath could successfully enforce their non-compete clause; however, they likely have plenty of lawyers on salary and you don't, so that can be very intimidating.

http://en.wikipedia.org/wiki/Non-compete_clause